Neurotic about her health, our writer went for a private 'health MOT' - and
wished she hadn't

Like many over-fifties, I am neurotic about my health, though I don’t smoke and I eat pretty well (aside from too many biscuits). I am also quite unable to resist a bargain. So I was easily seduced by the offer from a private screening company that recently landed on my doormat.

There was, said the personalised letter, a simple way to avoid a stroke and other killers – by having “cutting edge” and potentially life-saving tests that could detect warning signs of cardiovascular disease, such as dangerous build-up of plaque in the arteries. Five tests were being offered at the knock-down price of £199 (normal cost, £300). The company vowed it would put my mind at rest – or, should a problem be detected, something could be done before it was too late.

So it was that one rainy Monday morning I found myself in a draughty church hall, with a few screens thrown up for privacy – a set-up that brought to mind the NHS rather than a swanky private service. The tests themselves, carried out efficiently by paramedics (not a doctor in sight), were quick and painless, though hardly cutting-edge.

In the space of half an hour, I filled in a lifestyle questionnaire, had an ECG to detect an abnormal heartbeat and was given three ultrasound scans: one of my legs for signs of hardening of the arteries; one of my abdomen for the presence of any dangerous bulge in the aorta; and one of the large artery in my neck to look for any plaque build-up. I also had blood tests to measure levels of cholesterol, fats called triglycerides and glucose.

Three weeks later, my report arrived – all 16 pages of it – congratulating me on “having taken an important proactive step in maintaining your future good health”. The ECG and scans, I was relieved to read, had revealed nothing untoward, although my “good” (HDL) cholesterol was classified as low, while my “bad” (LDL) cholesterol was high (doctors these days are interested in the ratio between the two, rather than just total cholesterol).

It was when I turned to the “risk analysis” page, based on the lifestyle questionnaire, that I felt baffled. While the report said my risk of coronary heart disease was low, the risk of stroke and diabetes was “moderate” (whatever that may mean), and that of lung cancer and chronic obstructive lung disease (COPD) high. Since I had certainly ticked the non-smoking box and smoking is the main cause of lung disease, this seemed odd. Also mentioned, in the context of lung disease, was my “personal history of asthma”; I was allergic to pets as a child and to some extent still am, triggering asthmatic episodes.

Vaguely alarmed, I put in a call to the company and took the results to my GP, who snorted derisively, pointing out that my “good” cholesterol was a tiny fraction – 0.01mmol – lower than the recommended 1.2mmol for women; and my “bad”, just 0.03 higher than the recommended 3mmol. “If I had your cholesterol levels, I would be very happy,” she said.

“I’d like to see their evidence that you’re at risk of stroke and diabetes. It looks like a computer-automated cut-and-paste job to me.”

She was even more aghast at my allegedly high risk of lung disease. “Childhood asthma is not a risk factor,” she said reassuringly. “And even if you smoked when you were young, the risk would have gone down dramatically with time. Thank goodness you’re a journalist – an ordinary person would be very frightened.”

Some days later came a call from one of the company’s nurses, a sympathetic, softly spoken lady who said she was as mystified as I was over the high risk of lung disease, that her photocopy of the questionnaire was “a bit blurry”, but that perhaps I had been mistakenly assessed as a smoker and an asthmatic. She would have to “go back to basics” and consult the doctor.

A few weeks later, a revised report arrived, along with another “Congratulations…” letter. My risk of stroke, diabetes and lung disease were now classified as low. I was described correctly as a non-smoker, and all mention of personal history of asthma removed. Still, some confusion remained. A page marked “Action sheet” said I had never smoked in the past (wrong), but then stated how great it was I no longer used cigarettes.

Now, anyone can make a mistake and it is possible that the error was partly mine. I will never know how it occurred as the promised copy of my questionnaire never arrived. What is alarming is that, although the information had apparently been signed off by a doctor, no one had spotted the confusions and contradictions in what were clearly a set of automated results. An official response from the company said that the issue over my report had been “fully investigated” and “ambiguous responses” explained. Which is true; but as a medical journalist, I at least had some inkling of an error, whereas an ordinary member of the public might have taken it as gospel.

Aside from the confusion, did I learn anything new? No: I was advised to do what I already know I should be doing – exercise more and cut down on dietary fat. Was I reassured? Error aside, getting the all-clear from the tests had a certain feel-good factor.

Yet according to some doctors, many of the tests I had are a waste of time, or worse. The carotid artery scan is particularly ill-advised, according to Margaret McCartney, a Glasgow-based GP who says that private screening companies are exploiting people’s health worries without explaining the downside of some tests.

“If you are going to offer a screening test, it’s got to be one doctors can act on,” she says. “But if this scan finds someone has arterial disease, the risk of a stroke or death from the treatment [a carotid endartrectomy] is greater than if it is left alone.

“The test is useful for people who have had a stroke who are already at high risk of having another. But anyone else is just left with the knowledge they have arterial disease, without much they can do about it.” Similarly, she says, the scan for narrowed arteries in the legs was “absolutely useless” in someone with no symptoms.

But what about the testimonies from grateful patients, who feature in ads from several private companies, whose lives seemed to have been saved by screening? “It’s impossible to know if anyone’s life has been saved by a test,” she argues. “A test might just bring forward the point at which you know you are ill, without actually extending your life. The ones who died [after surgery for narrowed arteries] aren’t alive to tell their stories.”

The scans can also offer false reassurance. “You might be a smoker and overweight, but if everything looks perfect on the scans, you’ll feel you don’t have to do anything about it.”

In response, the company defended carotid artery screening, arguing that for most patients found to have diseased arteries, lifestyle changes are effective. It added that it “takes the quality and provision of information relating to the risks and reliability of its screening service very seriously”.

Dr Anne Mackie, director of the NHS national screening committee, argues that while screening intuitively sounds like a good idea, “a lot of the tests aren’t that helpful”. She advises anyone considering private screening to first check out which tests are available on the NHS (see panel), in which case they will have been “rigorously evaluated”.

“People should be told more about what is being offered and what happens if anything is found,” she says. “People are free to buy what they like,” she adds. “But even estate agents have to be honest about what they are selling.”